Provider Demographics
NPI:1760148456
Name:ELITE INFUSION CARE LLC
Entity Type:Organization
Organization Name:ELITE INFUSION CARE LLC
Other - Org Name:ELITE INFUSION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DASHEAVIA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:478-978-3347
Mailing Address - Street 1:13607 CORDARY AVE APT 122
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-7437
Mailing Address - Country:US
Mailing Address - Phone:478-978-3347
Mailing Address - Fax:
Practice Address - Street 1:1440 N HARBOR BLVD STE 916
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4127
Practice Address - Country:US
Practice Address - Phone:424-324-9322
Practice Address - Fax:424-349-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care